Jim Daly (Cork South West, Fine Gael)
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I thank the Acting Chairman for the opportunity to raise the issue of home help. By way of illustration I present the Minister with a case that is on my desk since early December 2015. Margaret is just out of hospital following major open heart surgery. She has had a number of strokes and has a tumour on the brain. She cannot work the nebulizer she needs to ease her asthma. Her husband, Pat, who has had two strokes, has cancer and many open wounds which need dressing three times a week. The only person who cares for this couple is Margaret's sister, who is 74 years of age.

I made representations to the HSE for home help hours for this couple in early December. I received a letter on 29 January stating that the request had been assessed by a professional who agreed that the couple required home help and recommended one hour five days a week. However, at the end of the letter I was advised that due to a lack of resources the couple would be wait-listed, which is the new buzzword for any application for home help, until resources became available. I heard back from the HSE on 21 April to say they had finally been allocated the home help. From 3 December 2015, when I got involved, until the end of April, the couple got home help of one hour, five days a week. This raises the question of why home help is not a service that is available seven days a week in the first instance. In pursuing some research recently I asked the HSE the number of people not only in west Cork but in the whole country who are currently wait-listed for home help. I understand that 1,700 people are wait-listed for home help at this point. I also asked the HSE what it would cost to allocate the home help hours needed for these 1,700 people, and it informed me on 11 May that it would cost approximately €10 million to eliminate the current waiting list for home help hours. The sum of €10 million in the context of the overall budget of the HSE is the equivalent of €14,000 in my hand and somebody asking me for €10 out of that €14,000. For those who are mathematically minded, 0.07% of the budget would eliminate the current waiting list.

The people we represent are very frustrated by this anomaly in the system. People who pay their taxes, go about their daily lives and do their work are frustrated that the HSE is cutting corners in home help, given that it would take people out of hospital, keep other people out of hospital, and relieve many problems associated with the build-up of patients in acute emergency departments and the trolley crisis. Yet this €10 million, which is a paltry sum in the greater scheme of things, is the budget that the HSE has targeted for reduction. It should not be a budget exercise; it should be demand-led. I hope the HSE management and the Minister will understand this and go forward in this knowledge.

In the previous Dáil, the Ministers, whether by design or choice, became Ministers for hospitals. I ask the Minister to take on ministering for primary and social care and home help issues. I would go so far as to say that the hospitals are working perfectly well. I am very proud of our hospitals in Ireland and the way they work. Anybody who is lucky to get into a hospital will say they get a great service. However, I understand from medical managers that about 50% of people in hospitals should not be there. They are taking up acute hospital beds. A little-known but important statistic is that in Cork University Hospital, 3% of medical patients occupy around 30% of the bed days. In other words, over a third of the entire hospital capacity is being taken up by 3% of patients, many of whom do not need to be there. The number of patients in hospital for more than 30 days is quite staggering. Some 50% of the capacity of St. Vincent's Hospital in Dublin is taken up by people who are there more than 30 days. It is important to address and eliminate this pressure point in hospitals. The hospitals work well for the people who get in. We need to free up capacity. We must start by having a Minister who will focus on primary care and home help and encourage people to stay at home by giving them this facility. I ask the Minister, for God's sake, to please ensure that home help is available seven days a week. The elderly, the vulnerable and the sick, about whom we all care deeply, are not sick and vulnerable five days a week; they are in need of care seven days a week. I hope the Minister will get that point across to the HSE and ask for the €10 million to address this anomaly, which would free up much capacity and eliminate many of the knock-on effects of overcrowding in the emergency departments.

Simon Harris (Wicklow, Fine Gael)
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I thank the Deputy Daly for raising this important issue and for giving me the opportunity to respond to some of the points he has raised in regard to the importance of home help provision in our community. I begin by agreeing with the point he makes that the role of the Minister for Health is not just to be a Minister for acute hospitals but to be a Minister who examines the continuum of care from primary care to acute care to social care, because one leads to the other. The worst thing that can happen in the HSE and the Department of Health is the creation of a silo mentality, or an attitude in which it is one part of the health service versus the other, because, as the Deputy has outlined very articulately, one leads to another.

Older people have consistently said to all of us in the House and to many others that they want to stay in their own homes and communities for as long as possible. The Government is committed to facilitating this. Home care services are key to achieving this and the strengthening of home care services is an absolute objective to which this new Government is committed. The Health Service Executive provides significant levels of home support and will spend in the region of €324 millionthis year on these services.

9 o’clock

The HSE's national service plan for 2016 provides for a target of 10.4 million home help hours to support approximately 47,800 people. It also provides for 15,450 home care packages and 130 intensive home care packages for clients with complex needs. A further 60 clients with dementia will be supported with co-funding from The Atlantic Philanthropies under the national dementia strategy. The service levels of 2015 are being maintained this year. I make this point because I have heard misleading comments, not from the Deputy but from others, on home help cuts. Service levels are being maintained this year and there has been no reduction in the resources available for home supports in 2016 compared to 2015. However, prudent management of available resources is needed as demand for services increases. The HSE is working to apply available resources to target most effectively those with the greatest need and to provide the best possible contribution to the service as a whole. Services are being stretched by demands from more people and for more hours at times outside core hours in the evenings and at weekends, as outlined by the Deputy, all of which cost more. Decisions on resource allocations are made and reviewed by front-line staff who are familiar with a client's individual needs and circumstances. All relevant factors are carefully balanced in order that as many people as possible can viably stay at home and enjoy the best possible quality of life. Those who cannot be provided with a service immediately are risk-assessed and placed on a waiting list for resources as they become available. The latest information available to me is that the current waiting time is between two and four weeks.

Notwithstanding the significant improvements in the overall economic position that we have seen in recent years, pressures continue to apply across the health service. There is no doubt that home care services need more resources than are available. For this reason the programme for Government commits to increasing funding for home help and home care packages, year on year, in the coming period. This is a commitment I wish to fulfil in ensuring additional resources for home help and home care packages in the next budget. In the meantime, I assure the Deputy that I am maintaining close liaison with the HSE on home care services and the implications for them. This is an issue which will continue to receive attention from me.